Training and Corrective Action
Joe Wojniak
90 Posts
Why does training get a bad wrap when used as a corrective action?
21 Replies
Amanda Foster
657 Posts
I think one reason could be that the term training is unspecific and can mean anything unless defined. If training is developed or given as a corrective action, there must be clear ties from the training to the RCA. Also, the effectiveness of the training must be determined and that can be difficult, That said, I think that training can be effective as corrective action if used properly.
In my operational practice, I always prohibit to put training as corrective action since prior to assignment of a job the worker has been qualified with training. Mean if there is a problem occur a it must be something wrong with the system. It is required to go deep dive on the root cause by why analyses rather than stop in lack of training.
Corrective Action is complex. In my experience I have witnessed organizations jump to "retrain" as the only response. It's important to really find out why the existing training (if there was any) wasn't effective and to really dig further into the issue. Training can be a part of the corrective action. Short answer: Shift the process and train on the new process. Thanks Joe for starting this important conversation. 
I agree with Susan that "retrain" is the knee-jerk response to CAs. I have been taught and now teach to dig deeper. Review work instructions, procedures, or even the paperwork the worker is filling out and find the gaps.  Remember, corrective action is a continuous improvement tool that should be used to close gaps in processes. 
May it be  a cultural factor in the organization? People see the CA as a punishment rather than the gift it is, opportunity for everyone to become better. 
 
Byron May
1 Posts
I would say two main reasons: 1) It relegates the corrective action to human memory, with all of its fragility. Six months later people may not remember everything the trainer said.  2) Also, Normal personnel attrition and turnover means that those who were trained may be gone. And if the new people were not treated the same way the correct of action is lost. Instead of just training, the correct of action should be built into the process and procedures which are reviewed regularly and followed closely by veteran employees and also the first thing we hand to new employees. 
Joe, Fundamentally Training gets the bad rap because more often than not it is symptomatic that the Deviation investigation and root cause analysis process did not get to the root cause of the problem and thus training alone will not solve the problem. When more than 90% of the root causes identified are personnel error and the corrective action is re-train - there is a failure to understand the process was designed (hopefully) with human operators in mind and the training program was designed (again hopefully) to instruct the operators in running the process. When the process fails - is it the process or a bad training program? By jumping to training as the corrective action, you simply magnify the problem instead of one problem (the one you are trying to fix) you now have two (the original problem and why did the training program not work).
Training can be the issue of the larger problem (training process) - most cases not.  Ask yourself = does the person have the knowledge and ability to do the task correctly?  If so, training will not help.  Look at the process and use Poky-Yoke, (mistake proofing) to change the process (design) so errors cannot happen or you can discover them quicker in the process so not to pass them on.
 
Training, by itself, points to a deficiency in your program. 
If you couple training with an assessment and/or some revision of your ongoing program to prevent this deficiency from occurring again, then it should be a viable option. 

 You need to look beyond this single incident and see why it was allowed to begin with.
 
Kelly Gau
7 Posts
I agree with the previous responses. The purpose of the investigation is to define the root cause(s). The purpose of the corrective action is to address that/those identified root cause(s). Unless lack of training is identified as your root cause, retraining should rarely be used as a corrective action. And if it is, that opens up a whole other issue, where a CAPA should be used to address why there was a lack of training in the first place (unless that was also identified in the deviation). I review many deviations/non-conformances from many different organizations (we outsource work), and typically we see training as a band aid response. If there is training in place already, why was that initial training not effective? Why would retraining be any more effective? Would those who are not part of the "retraining" (i.e. new hires) be aware of the issue identified in the the deviation/non-conformance, or will the issue be repeated if only trained using the same initial training method? Tribal knowledge is never a robust method for transferring information, so if the expectation is that you can reinforce something by repeating it that isn't clear initially, from an external perspective, that seems dubious. As a side note, human error should also rarely be a root cause. If people are making mistakes, it probably isn't because they want to. There is probably something with the process that is not clear, or a hindrance of some sort that should be identified and improved to ensure they are able to perform without error. That would be the actual root cause. Again, this is why retraining is frowned upon. It implies the true root cause has not been identified.

When we push back on training as a CA, it is often because we have seen a repeat occurrence of the deviation elsewhere, or see the risk of a repeat when there is not an additional change implemented to the system. 
In addition to Amanda's comments, it's required that personnel are trained prior to performing the work, so if you use training as a corrective action, then in the root causes analysis, there should be data to support that there was a gap in the training that was competed or there is a systemic issue with your training process.  If retraining, what will be done to ensure that the new training will be effective.
The bad wrap training gets is when the training does not address the system cause.  You need to go deeper into RCA to SRCA (system root cause analysis).   This is difficult because we are criticizing who designed the system.  Dr. Deming taught me that you currently have the perfect system for the results you are getting.  Unless training is used for system corrective action it will get a bad wrap.  
Training is an essential part of doing business. But as a corrective action it is only a short term fix, since the people you provide this training to don't live forever and new people are hired. So something more systematic is needed. If the training is a standard part of onboarding or moving into certain positions then it starts becoming preventive, or long term. 
 
The quote below is taken directly from CMS's QAPI at a Glance which quotes the Department of Veterans Affairs.  Note that training/education is considered a weak action.  This has helped me in the past.

The Department of Veterans Affairs National Center for Patient Safety’s Hierarchy of Actions2 classifies corrective actions as:

Weak: Actions that depend on staff to remember their training or what is written in the policy. Weak actions enhance or enforce existing processes. Examples of weak actions: •• double checks •• warnings/labels •• new policies/procedures/memoranda •• training/education •• additional study

Intermediate: Actions are somewhat dependent on staff remembering to do the right thing, but they provide tools to help staff to remember or to promote clear communication.
Intermediate actions modify existing processes. Examples of intermediate actions: •• decrease workload •• software enhancements/modifications •• eliminate/reduce distraction •• checklists/cognitive aids/triggers/prompts

Strong: Actions that do not depend on staff to remember to do the right thing. The action may not totally eliminate the vulnerability but provides strong controls. Strong actions change or re-design the process. They help detect and warn so there is an opportunity to correct before the error reaches the patient. They may involve hard stops which won’t allow the process to continue unless something is corrected or gives the chance to intervene to prevent significant harm. Examples of strong actions: •• physical changes: grab bars, non slip strips on tubs/showers •• forcing functions or constraints: design of gas lines so that only oxygen can be connected to oxygen lines; electronic medical records – cannot continue charting unless all fields are filled in •• simplifying: unit dose
Joe Wojniak
90 Posts
Thanks, everyone for the in-depth replies!  I'll be sure to remember this advice when participating in root cause analysis and corrective action.
A corollary to the useful discussion might be that “human error” is a weak root cause.
Training in TQM culture is given before a regular or temporary team member is assigned to do a job.
Training is not an assignable cause of the corrective action process.
The management responsibility is to ensure a system of check and balances is in place in the effective training process.


 
Great question, Joe. And based on the volume of responses, you've obviously tapped into a hot topic.

I think training gets a bad rap as a corrective action not because it can't address the root cause of the issue, but because it's been too often applied when in fact a lack of training was not the root cause of the problem. In other words, the mass of people who sloppily completed 8D's have tainted the tremendous value of training as a corrective activity. (Maybe it's a lack of training in 5-Why Analysis??) In effect, it seems like a bunch of quality professionals "threw the baby out with the bath water" when they decided that training can't be a stand alone corrective action.

Nonetheless, like so many others, I rarely list "training" of any kind as a stand alone corrective action, but instead I use it widely to supplement other, more tangible activities.

And now for a shameless plug: I do teach a 9-hour long online class titled "Root Cause Analysis and the 8D Corrective Action Process". In it I address a wide range of tools and concepts related to RCA and corrective actions including "softer" tools like training and quality alerts. ASQ members signing up with the link below will get lifetime access to the entire class for $13.99. The coupon is valid for the next 30 days.

https://www.udemy.com/course/root-cause-analysis-and-the-8d-corrective-action-process/?couponCode=FAFD086494F4916FCF61

Thanks again for the excellent question ... I hope you found the range of opinions you were seeking.

Ray Harkins
themanufacturingacademy.com
Luigi Sille
110 Posts
Hi Joe, 
Training can be part of a corrective action, after performing a root cause.
The thing is employees sometimes experience this as a way of punishing them for doing something wrong.
Has to do with the organizational culture.
But why wait till something happens to dig in deeper, to find out that someone or the whole team needs
training.
Planning yearly training and measuring the effect of the training,  will have positive value for the team, and the organization. Human
errors can still happen when we plan regular training, but it will decrease. 
My concern is that measuring the effectiveness of training has always been NEGLECTED.

Great topic Joe




 
This is a great topic of discussion, and very timely for me since we currently have a CAPA in progress where lack of training and improper documentation are driving factors. We know that training is a difficult corrective action to verify effectiveness so we asked one more “why”. Why did we not have the proper training and documentation in place? In our case, the corrective action wasn’t training per se, but adding the topic of training to the requirements of the manufacturing readiness review to ensure that training takes place. This addresses the systemic problem (and is much easier to verify effectiveness).